renal, testicular and penile cancer

Question 1

what are the most common benign renal tumours?

Answer 1

simple cysts
angiomyolipoma
oncocytoma

Question 2

what are the most common malignant renal tumours?

Answer 2

renal cell carcinoma
transitional cell carcinoma
lymphoma

Question 3

describe oncocytoma

Answer 3

Spherical, capsulated, brown/tan coloured

Radiologically very difficult to differentiate from Renal cell carcinoma

Has got central scar/ Spoke wheel pattern

doesn’t metastasise

Question 4

describe angiomyolipoma

Answer 4

80% of patients with tuberous sclerosis will develop

bright echo pattern on ultrasound

4m cutoff for treatment- embolisation, partial nephrectomy

Question 5

what type of tumour is renal cell carcinoma?

Answer 5

adenocarcinoma of the renal cortex

Question 6

what are the types of renal cell carcinoma?

Answer 6

Conventional clear cell carcinoma
Papillary
Chromophobe
Collecting duct
Medullary Cell

Question 7

what is the appearance of renal cell carcinoma?

Answer 7

Tan coloured, lobulated and solid

10-25 % contains cyst or are predominantly cystic

Question 8

what is the presentation of renal cell carcinoma?

Answer 8

Haematuria, loin pain, mass. All 3 together in less than 10 % cases.
Pyrexia of unknown origin ( 8-9 %)
Varicocoele
Paraneoplastic syndrome ( 30%)

Question 9

what investigations do you do for renal cell carcinoma?

Answer 9

USS

CT Chest abdomen, pelvis for staging.

FBC

Renal and liver functions

Question 10

what is the treatment for renal cell caricnoma of 3-4cm

Answer 10

Surveillance in elderly unfit patients
Ablation techniques in fit elderly patients and selected younger patients
Partial Nephrectomy

Question 11

what is the treatment for renal cell carcinoma of 4-7cm?

Answer 11

Surveillance
Ablative techniques
Partial nephrectomy. Robotic technique becoming the most common approach
Radical nephrectomy

Question 12

what is the treatment of renal cell carcinoma larger than 7cm?

Answer 12

Radical nephrectomy. Laparoscopic approach gold standard

Question 13

which type of testicular cancer is more aggressive?

Answer 13

non-seminomatous (teratoma)

Question 14

what is the clinical presentation of testicular cancer?

Answer 14

Scrotal lump
Delayed presentation occasionally seen
5 % acute pain due to bleeding
10 % symptoms of advanced disease including weight loss, neck lumps, chest symptoms or bone pain - can happen due to undescended testes so they don’t notice the lump

Question 15

what is seen on examination of testicular cancer?

Answer 15

Asymmetry or slight scrotal discoloration

Examine the normal side first

Hard, non-tender, irregular mass mostly intratesticular

Assess involvement of epididymis, spermatic cord and scrotal skin.
Secondary hydrocele

Question 16

what investigations and blood tests do you do in suspected testicular cancer?

Answer 16

Ultrasound scan for testicle
CT Chest abdomen for staging - look for metastasis

Blood tests:
Serum tumor markers
Alpha Feto Protein
B- HCG
LDH
Raised in 50 % cases
FBC
Liver function tests
Renal function tests

Question 17

what is the treatment of testicular cancer?

Answer 17

remove testicle- radical inguinal orchidectomy

no biopsy, chemo, radiotherapy etc. it offered

incision is made in the pelvis so the tunica vaginalis is not cut and cancer is confined

Question 18

what is the most common penile cancer?

Answer 18

squamous cell carcinoma of the skin

also can get kaposi’s sarcoma - HIV
bcc, melanoma, sarcoma are rarer

Question 19

what are risk factors for penile cancer?

Answer 19

Age : 5-6 th decade
Phimosis : Chronic inflammation
Geography : Asia, Africa, South America
Human Papilloma virus : Types 16 and 18
Smoking
Immunocompromised patients

Question 20

what are the most common sites of penile cancer?

Answer 20

Glans – 48 %
Prepuce – 21 %
Glans and prepuce – 9%
Coronal sulcus – 6 %
Shaft – 2 %

Question 21

what are the treatment options for prepucial and glans penis lesions?

Answer 21

Prepucial lesions - Circumcision

Glans lesions
Superficial : Glans resurfacing
Deep : Glansectomy

Question 22

what is the treatment for advanced penile cancer?

Answer 22

Total penile amputation with formation of perineal urethrostomy